Saturday, September 3, 2011

12 Tips for a Rewarding Nursing Career

Every once in a while it's a good idea to take stock of your life and your career, and take steps to get yourself back on track, or even change direction if that is what is needed.

Here are 12 things you can do for yourself, as a nurse, to make your career more fulfilling and to avoid nurse burnout:

Nurse stress management is a must. Learn techniques that work well for you and use them routinely.

Managing your time efficiently and effectively is vital. Become organized, stay on top of things, and do not procrastinate!

Replenish yourself. Make time for yourself and do it often! Nursing is a demanding/giving profession. If you have given all you have to give, then you have nothing left for yourself, and you can't continue to give - you'll have nurse burnout.

Nursing is a lifelong learning process. Use your continuing education opportunities to stay up to date with your selected field and to learn and hone new skills. Secondly, make sure to learn something about other fields of nursing whenever you can. Know your options and keep them open.

Nurses are overachievers. Strive for excellence and set the bar high. Do not settle for mediocrity. Encourage others to do the same.

Be a nurse mentor. Help those around you to strive for and achieve excellence as well. Always being a nurse mentor throughout your career is the key to providing excellent quality care with the best possible outcomes.

Be a sponge. Learn from others. Pick up on their tips and tricks and then share them with others.

Always be a part of the solution and not part of the problem. Get involved in strategic planning for your workplace and help to make it a better place.

Be a good TEAM player. Be a nurse leader when you need to be and a nurse supporter always. There is no “I” in TEAM. Be good role model to others who “just don’t get it,” and help them to become team players too.

Learn your limitations and how and when to say "No." Respect yourself and always set a good example for others. It’s simply not possible to say “yes” every time and not get burned out!

Remind yourself often WHY you became a nurse.

Encourage others to become nurses and to strive for excellence.

Nursing is one of the most rewarding careers you can find, but it is also physically and emotionally demanding and draining. Take time for yourself so that you have something more to give when it is needed. And when you find yourself stressed and burning out, remind yourself why you became a nurse.

About the Author: Kathy Quan, RN, BSN, PHN is an accomplished writer and author of four books including: The Everything New Nurse Book and 150 Tips and Tricks for New Nurses. Kathy has been in the nursing profession for over thirty years, and is very passionate about patient education and mentoring new nurses.

Sunday, August 28, 2011

Nurses Heal Thyself: A Culture of Silence

By: Kathleen Bartholomew

When Shelli was a new scrub nurse with only six months experience, she failed to anticipate that the surgeon would need a particular scalpel. Immediately, her preceptor deftly slapped the correct blade into the impatient surgeon’s outstretched hand with a glare in Shelli’s direction. The surgeon said nothing, but a look of disappointment briefly flashed across his face. At that moment, Shelli learned that if she was not on top of the surgeon’s needs, she would end up feeling embarrassed and looking incompetent. Shelli did not find this information in her orientation manual.

We learn these unspoken rules very quickly in order to survive. We know which physician not to ever call in the middle of the night, which nurse talks about us behind our back when we ask a question, and whether we should even bother to write up an incident report or approach a coworker with a concern we have about ‘their’ patient. This knowledge is vital to our survival because it determines whether or not we will be accepted by the group.

It’s called culture. Human beings rarely, if ever, succeed at accurately perceiving their own culture. Anthropologists say, “It’s like a fish talking about water. It’s the last thing the fish ‘sees’ because it constantly surrounds him.” Yet nothing is more powerful than this unseen force. So deeply entrenched is culture that no one talks about it: the unspoken rules and behaviors (called ‘norms’) are never written down, and yet everyone knows them. We learn these norms the hard way by the process of assimilation – like Shelli’s story above.

When individuals merge and form a group, there are always things they can do, things they must do and things they can never do. For example, healthcare workers do not typically share their feelings in high-tech, high-pressure environments because feelings are perceived by the general culture to be ‘soft stuff’. Ironically, this belief couldn’t be further from the truth. Feelings not only matter, but are conveyed unconsciously because 93% of all communication is non-verbal. In a study of collaboration among residents, nurses and physicians the single most important factor to producing positive collaborative outcomes turned out to be affect – our bodies consistently express what we feel (McGrail). For example, think of your own workplace. Is there someone you work with who you think doesn’t like you?

They don’t.

The feeling you are getting that someone doesn’t like you –even if they’ve never said anything- is dead on correct. Herein lays the problem and the biggest contributor to nurse to nurse hostility – a culture of silence. We don’t check out the intended message in the non-verbal interaction. Nurses rarely if ever confront each other because their main style of communication is passive-aggressive and nurses are known to be conflict avoidant. When over 4,000 nurses were asked why they don’t speak their truth, the answers were consistent (Bartholomew):

1.Fear of retaliation: someone refusing to help me, a bad assignment, denied a vacation day, a bad schedule

2.Fear of hurting someone else’s feelings or making the situation worse

3.Why bother? Nothing is going to change anyway

4.Fear of isolation, rejection, gossip

5.They’ll turn it around and it will be my fault; it’s not worth it.

First, we have to admit that having some conversations requires courage – especially if the conversation should have happened a long time ago. And then, we need to learn a new communication model – like the “Juice Pull Conversations” -which allows us to confidently speak our truth. Remember starting your first IV? Remember the nervous fear of hurting someone unnecessarily, of puncturing the vein? But after starting a hundred IV’s, you feel skilled and competent. The same is true for the skill of engaging in difficult conversations – the first one is always the hardest. But the damage of not having the conversation is far worse - like gangrene for our profession because we don’t sense the urgency or see the damage.

This is what Ghandi meant when he said, “You must be the change you want to see in the world”. We could complain for years about staffing grids, missed meals or stressful work conditions. Or we could start a tsunami of change for our profession and our patients. If every nurse spoke their truth, we would heal ourselves; and thereby become a blazing beacon of healing for a wounded world.

Saturday, August 13, 2011

Lateral Violence in Nursing: Breaking the Spell

By: Kathleen Bartholomew

A nurse rolls her eyes at a co-worker as she picks up the assignment sheet that was created by a younger charge nurse. An ICU nurse pretends not to see her co-worker is drowning and ignores her request for help saying she is ‘too busy’. A newly hired RN who was previously a scrub tech finds she is now shunned by both groups. Is this just life as a nurse - or a nurse’s right of passage? Or is it something more insidious?

These behaviors go by several names: lateral or horizontal violence, incivility, nurse-to-nurse bullying, sabotage - “nurses eating their young.” In general, bullying in the United States is a term used to describe uncivil behavior from someone who has power over you – vertical aggression. Rude behaviors from peers are referred to as horizontal or lateral hostility and are defined as: “A consistent pattern of behavior designed to control, diminish or devalue a peer (or group) which creates a risk to health or safety” (Farrell, 2005). Some specific examples are:

Covert: unfair assignments, refusing to help someone, ignoring, making faces behind someone’s back, refusing to only work with certain people – or not work with others, whining, sabotage, exclusion, fabrication

Estimates of lateral violence in the nursing workplace ranges from 46–100% (Stanley et al. 2007). Nursing literature abounds with examples of prevalence. In one study, one-third of nurses perceived emotional abuse during their last five shifts worked (Roche). In another survey, 30% of respondents (n= 2,100) said disruptive behavior happened weekly, and 25% said monthly (Advisory.com). And a study of emergency room nurses found that 27.3% had experienced workplace bullying in the last six months with many staff bullied by their managers, charge nurses or directors as well as physicians and peers (Johnson, Rea). Bullying behaviors are like gangrene – when tolerated from a few physicians or nurses with strong personalities, the behaviors spread and infect the entire team – and eventually, the patient.

Lateral violence needs to stop. Bullying behaviors create a toxic work environment which not only harms nurses, but also our patients. Experts agree communication breakdowns and lack of teamwork are a root cause of errors. If nurses are afraid to speak up because they are intimidated by fellow nurses and physicians, patients can be harmed. Research also shows that simply witnessing rude behavior ‘significantly impacts our ability to perform cognitive tasks’ (Porath). From a very ethical perspective, tolerating bullying behaviors is wrong and violates our basic oath to keep patients safe.

But maybe we need another oath? Maybe it’s time we promise to keep each other safe; to nurture, support and protect each other because we understand and recognize how vulnerable we all are and the critical role we play in healthcare. In April, after accidentally drawing up the wrong medication which resulted in a child’s death, an experienced nurse took her own life. Her suicide is a result of our failure as a system, and as a profession, to provide a safe harbor for the delivery of care. Who knows what else was going on in her mind, or the details of the situation? All I know is that it could just as easily have been me who made the error.

Where do we start? A Chinese magician once said, “If you want to take power away from anything, call it by its name”. The overt and covert behaviors listed above are not ‘normal’. They are examples of lateral violence that cause serious and long lasting damage to our patients and to each other. They are wrong. Work your magic - say so!

Have you seen or experienced nurse bullying in the workplace? What was done about it?

About the Author:Kathleen has been a national speaker for the nursing profession for the past nine years. Her strong background in Sociology laid the foundation for correctly identifying the norms particular to the healthcare culture. For her Master’s Thesis she authored “Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication”which is the only book to date on physician-nurse communication.

Saturday, August 6, 2011

5 Tips for Working with a Difficult Physician

Working with a difficult colleague is tough enough – but when the colleague is a physician, it can be all that much harder. For the most part, doctors are great colleagues, and when doctors and nurses work well as a team, the best of care can result. But, as much as some doctors are fantastic both personally and professionally, others, well, they can leave a lot to be desired.

First, we need to define what we mean by “difficult.” If we’re talking about a physician with a rough bedside manner, but who is still doing his or her job and isn’t causing too much uproar in the nursing station or on the floor, I don’t think I’d call that difficult. If the patients are happy with the care, and you’re getting what you need in terms of orders and support when you need it, I’d probably let that pass.

Second, we need to separate “difficult” from difficult for us as colleagues or difficult with the patients. When a physician is difficult with the patients, then we have an obligation to step in; we are the patients’ advocates, and we can’t allow less than professional behavior from the physicians towards our patients. When we have a physician who is difficult to work with, we have to decide how and when to deal with the situation.

5 Tips for working with a difficult physician:1. Own your reaction: How you react to the physician is your own action. You can choose to react calmly or angrily; you can choose to walk away or confront. Which ever you do choose, it is your choice.
2. Examine why the actions of the physician are difficult for you: Is it because he or she reminds you of something; is he or she being difficult to just you or to the whole floor?
3. Refuse to accept bad treatment: You can choose to do this in a few different ways:

• Say calmly, “I don’t appreciate you speaking to me like that."

• Walk away without saying a word.

• Walk away while saying, “Please come speak to me when you can speak to me respectfully.”

• Stand there and don’t say a word.

4. Document: You have to document bad behavior. If you have a paper trail of the behavior, you can back up your claims if you choose to go on to the next step.
5. Report the behavior: Often, a physician with a bad attitude or who behaves badly gets away with it because he or she is not reported. When someone does get fed up and does report it, the administration says that they can’t do anything because there haven’t been any previous complaints.

None of the above tips may be easy; there are lot of work dynamics that differ from institution to institution, and even from floor to floor. But a work environment has to be comfortable for everyone, and if you work with a bully, be it a fellow nurse or a physician, it must be dealt with before it goes too far.

Sunday, July 31, 2011

Should There Be a Dress Code in Nursing?

By: Rachel Clements

I have the distinction of being nicknamed “Rapunzel” by one of my previous nursing supervisors. The reason is really straightforward: I have waist-length blonde hair that I often wear down. Fortunately, no one has climbed into it and it has only been pulled once, by a little boy who told me I looked like an angel. Knowing all of this, you should conclude that I am a violator of one of the many laws, written and unwritten, of the nursing dress codes: nurses must always wear their hair up.

Now, let me qualify this: the hair goes up before I do procedures, assess patients, complete cares, and even chart. Sometimes I even do it unconsciously when work gets particularly intense, like when dealing with difficult families or trying physicians. A couple of co-workers have observed that I am getting down to, and mean business, when I pull my hair up into a bun or a pony tail.

I am a firm believer in form following function, and am something of a pragmatist. Here are my thoughts on some of the more controversial aspects of the nursing dress code:

Nails: I honestly don’t believe that long acrylic nails have a place in nursing if you are a staff nurse. Why? Because germs hide out under your nails, you could scratch someone (including yourself), and if they get torn off, those puppies seem to hurt even more than breaking a regular nail. That being said, I think that nurses should have nice nails. There is something out there called a nurse’s manicure that will remedy this, but the basic idea is to have neatly trimmed nails with healthy cuticles. As for color, some facilities insist that nails be free and clear of this. Nurses need to be aware of what their hospital policy is for this. My opinion is that your nails should reflect how you want to be perceived. I was told long ago that pink is a good color for professionals, but it’s really up to you. To be on the safe side, leave the flashy stuff for your toes. I myself have purple sparkly ones.

Scrubs: The controversy rages on about going back to a standard uniform for nurses, namely whites. Being a self-proclaimed pragmatist, I’d like to point out that white is very difficult to keep clean. This is an argument I have made since nursing school, when I was required to wear whites. Many of us can’t keep a white t-shirt free of ketchup; how will we keep a white uniform free of blood stains? Whites may represent nursing from the not-too-distant past, but we are a different group of people from back then. We care for more critically ill people, we deal with more diseases, and we are responsible for completing more tasks and procedures. With that comes quite a bit of messiness… As for scrubs themselves, I think that these should be tasteful to ourselves and the groups of people we work with. You’ve got to know who you are working with. There are some people, young and old alike, who totally dig the Marvel and DC Comic characters. They are the start of some great icebreakers, also with young and old alike. But, above all, try to avoid being provocative with low cut tops or bottoms; if you don’t want people looking down your shirt or at your butt, wear something else or cover it up.

Tattoos and Piercings: I really love tats…on other people. They have yet to create the Mood Tattoo, something that will change shape to match how I feel. When they come up with this, I will be the first in line for one, something alternating between angel wings and dragon wings. As for wearing body art and piercings, I think you need to consider who you are caring for. Some people are ok with it, and others only see the stud in your nose or the ink on your arm and not that you are the most skilled nurse on the floor. Most importantly, can you cover it up if needed? If you have a patient who is afraid that the Terminator is hunting him down, it would be good to cover your cybernetic arm that was so meticulously inked before becoming a nurse in order to keep them calm. Along those lines, you might have a patient who is trying to remove the little bug from your nose and is leaping from the gurney to get to you. Covering these up will prevent a lot of paperwork, administering prns, and even injury.

Hair: At last we come full circle. I can tell you now that I will not cut my hair, but I am more than willing to wear it up in a ponytail or bun, or back in a braid. If you can pull off a perfectly bald, shaved head I say go for it, whether you are a man or a woman. My scalp is envious because of all its bumps and scars; there are always nice “do rags” out there if you get cold or funny looks. But, as I’ve said before, how you present yourself to the world is how most people perceive you. Once I had an ER doctor who wore dreadlocks and immediately I made the assumption that she wasn’t cut from the same cloth as many of her colleagues. I was right, and as it turned out, she could also tap dance and sing goofy songs as well as provide me with the best medical care I had ever received. I have never had problems with dreadlocks, but I know that this might not be the case for others. If you want people to think you are the kindest, gentlest, most approachable nurse in the hospital, the day glo green Mohawk probably won’t reinforce this image.

So, it all comes down to this: awareness of hospital policy regarding dress code, awareness of how you are perceived by other people, and awareness of society’s norms regarding what is “proper” for nurses. There are variations within these, as some hospitals have psych units that do not require nurses to wear scrubs, some people may be used to seeing you without your hair down, and patients may have grown up with the nurse in the white uniform but like your mauve scrubs much better (“that is definitely your color, sweetie”). All the same, just be aware and consider that you may have to make some changes. Whatever happens, let people see you as an individual, a professional, and as a nurse.

Should there be a dress code in nursing? What do you think?

About the Author:Rachel E. Clements is one of those "second winders" who began training in one career field and chose nursing instead; she has been a nurse for 5 years in May. Rachel lives and works in Boise, Idaho, and is currently enrolled in Montana State University's online Psychiatric Mental Health Nurse Practitioner program. In her spare time, Rachel enjoys hiking, savoring the sunshine with her two kitties, and tending to the yard of her relatively new house!

Saturday, July 2, 2011

I do not think of myself as a smiler. It’s not that I am unhappy all the time, or that I dislike smiling, I just don’t make a conscious effort to do so. I have other things which I consider to be a priority, but I do laugh easily and quickly. Even at work. Apparently the fact that I don’t have a smile or any variation thereof plastered on my face all of the time earned me the nickname “Nurse Frowny Face” from one of my patients, who was offended by my lack of smiling. Well, that wasn’t the only problem, as I had asked her to please keep her voice down in a hallway that has acoustics better suited for a concert hall than a psychiatric unit, when she wanted to know if everyone had gone out to smoke without her. Sigh. This earned me a meeting with a supervisor about being rude…

I am all for maintaining a professional demeanor but I absolutely refuse to put a smile on constantly for anyone, including the patients. I believe that if you maintain such a demeanor all the time and without variation, you come across as superficial, annoying and insensitive to patients, among others. It is ok to cry with them, to feel anger and annoyance for (and even with) them, and definitely ok to laugh with them. However, to insist that a nurse be smiling and sweet all the time to “cheer up” the patients, especially depressed ones, is asinine. We are not robots who are programmed by those around us to function at what they perceive to be an optimal level; we are only human. Having been a patient, I would not want a bubbly nurse when I am in physical or emotional agony. I want one who can introduce him or herself, look into my eyes, and empathize with me without being swallowed up by my pain. If he or she can “mirror” my emotions, I am convinced that he or she is following how I feel without taking on my problem. I believe that, above all, being genuine and kind facilitates the healing process, not the expression on my face.

Being a good nurse requires excellent psychosocial skills, in particular mastery of your interpersonal skills. “Enhancing your calm” is essential. It is also important to not be a doormat, as you are an individual just as worthy of kindness and respect as the next person. You have the right to ask to be treated as such. But, there are also going to be times when you slip, times when you let ‘er rip and say something which you may regret later. All you can really do then is apologize and acknowledge that you were out of line. In the meantime, and hopefully prolonging this event until your very last working day before retirement, I believe it is important to spend some time reflecting on what or who pushes your buttons. Come up with some strategies for coping with these. It might be a matter of taking a course in assertiveness to help you communicate in a way that is both pleasant toward others and protective of your feelings. It might also be a matter of knowing when to stop trying to be Super Nurse on the Unit, asking for help, and/or taking a break when things are particularly rough. Sometimes you should just let things slide, as we have a lot to worry about as it is. Either way, setting limits with patients, co-workers, physicians, and families is important. I find that when I can strike a balance with this, the expression on my face doesn’t matter. My eyes sparkle, my voice is warm and pleasant, and I am able to remain totally enthralled with the growth I witness within my patients because I can help nurture it.

About the Author:Rachel E. Clements is one of those "second winders" who began training in one career field and chose nursing instead; she has been a nurse for 5 years in May. Rachel lives and works in Boise, Idaho, and is currently enrolled in Montana State University's online Psychiatric Mental Health Nurse Practitioner program. In her spare time, Rachel enjoys hiking, savoring the sunshine with her two kitties, and tending to the yard of her relatively new house!

Saturday, June 18, 2011

Nursing. It’s Not Just a Career – It’s a Calling

Nursing. It’s not just a career – it’s a calling.

My hospital used that as an advertising campaign a few years back. Effective, yes, but is it true?

We think of nursing as a job, our work, a profession (which it is). It’s what we do – a choice we’ve made. Nurses can live comfortably on our incomes and even in hard times, there are usually jobs to be had.

And the variety! E.R. and flight nursing for adrenaline junkies, floor nursing for those gifted in multi-tasking, Intensive Care for techies, hospice, school nursing, home and public health – the list goes on and on.

I went around the unit last week asking random colleagues why they’d become nurses. Had they pro-and-conned their way into the field, decided they needed something to “fall back on” (as my mother used to say), or heard a voice from Heaven?

As to the last, no one had.

Their faces softened, though, as they considered how they’d ended up in this place, caring for a living.

Megan, a Gen Y nurse, didn’t feel called. “It was just what I always wanted to be,” she said. We discovered we shared a fondness for those little plastic nurses’ kits when we were little girls thirty years apart. Neither of us wanted to be the doctor.

Denise couldn’t come up with a reason. Yet, here she is with a bright shiny Master’s Degree, beginning a preceptorship as a Nurse Practitioner, after many years at the bedside. Called? She couldn’t say so.

Being a nurse is a privilege. And a calling.

Like many nurses, I shy away from saying such a thing out loud, but, here’s the truth: I am called to nursing.

Not by an audible voice or a sign from God. Rather, I have been drawn gradually and steadily to this work, my vocation.

Vocation.

No less than the Oxford American Dictionary uses nursing as an example of a vocation – a word that literally means a calling. Novices in religious orders want to know if they have a vocation. Nurses do too; my best friend quit nursing school because she didn’t feel enough compassion for the patients. My hospital’s nurse residency program gives new graduates the opportunity to try out different specialties to find a good fit.

Some of us pray.

I didn’t originally see myself as called. I needed a better-than-minimum-wage job. Then I remembered my childhood love of nursing. I moved near a university with a good nursing program. I got my paperwork together and registered just in time for the Fall Quarter. I thought all of this was good luck.

I surprised myself by doing well in the sciences (I hadn’t in high school). Our class quickly tired of books, longing to see real patients. I loved it.

I found I was suited for this. I had a shirt that said “Nurses Make It All Better”, and for a while, I believed it.

Then discovered it wasn’t true. I saw death. And worse.

But kept coming back.

And started to see beyond the sadness and secretions, the chaos and complaining, to the secret that this work is so much more than a succession of tasks to be done. We nurses are in the unique position of being able to act as instruments of healing – listening, touching, validating, soothing.

My sister called me one day and said, “I wish I could do something important like you. Your work matters.”

These things drew me. I wanted to be good at this, to gain new skills, and I did. I learned that listening was as much a skill as starting an I.V. Doing nursing well became less like gaining competence and more like participating in an intricate dance, relating and responding to my patients and co-workers with humility and (I hope) patience.

Like hearing the sound of a voice without understanding the words, I turned to the call and followed it. I moved toward what was beautiful and sacred in nursing, occasionally catching a glimpse of what lies just below the surface of our ordinary days of tending to and attending to our patients.

We may not be aware of our call or maybe we just don’t want to speak of something so holy. But, oh yes, we have a vocation.